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Background and objective: The ease of endottacheal intubation has been recently shown to affect the incidence of laryngeal injury. There remains controversy as to whether or not a muscle relaxant is routinely required for tracheal intubation. This study examined conditions of intubation in our routine practice, which employs a relaxant-sparing approach. Methods: All adult patients scheduled for surgery with general anaesthesia were prospectively included. A muscle relaxant was used to facilitate intubation when it was required for the surgical procedure and/or otherwise regarded as necessary by the anaesthesiologist. In the remaining patients, a relaxant-free intubation was performed. Intubating conditions were evaluated in all the patients as well as the post-intubation laryngeal symptoms. Results: Between March and July 2003, 612 patients were consecutively included. A muscle relaxant was used in 32% of patients and no relaxant in the remaining patients (68%). Clinically acceptable intubating scores were observed in 98.4% overall with no significant difference between the two groups. Excellent conditions occurred more frequently in the relaxant group as compared to the relaxant-free group, 87% vs. 72%, P = 0.005. Laryngeal symptoms occurred in 184 (33%) patients with no difference between the two groups. Conclusions: Our relaxant-sparing approach did not increase the incidence of poor conditions of intubation nor laryngeal symptoms. However, excellent conditions occurred more frequently in the relaxant group. A more flexible approach to the issue of the need for neuromuscular blockade prior to intubation is proposed. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to describe all degrees of endotracheal intubation difficulty among patients attended by eight anesthesiologists during routine surgery over a six-month period. Airway characteristics were routinely assessed preoperatively, according to the anesthesiologists' usual practice.Methods: Difficult tracheal intubation was evaluated by the Intubation Difficulty Scale (IDS), a quantitative score based on seven variables. An IDS value of 0 is consistent with a procedure without difficulty, and an IDS > 5 with a procedure involving moderate to major difficulty.Results: For 1171 patients undergoing tracheal intubation, IDS was 0 in 55%, and greater than 5 in 8% of cases. External laryngeal pressure, repositioning the patient and added use of a stylet were the most frequent methods chosen to facilitate tracheal intubation.Conclusion: There was a high incidence (37%) of minor difficulties encountered during routine surgery. [ABSTRACT FROM AUTHOR]

Objectives. – To study direct and indirect effects of EPO on haemostasis.Study design. – Experimental, randomised.Animals. – Forty-eight New Zealand rabbits.Method. – Animals were anaesthetised, ventilated and monitored continuously for blood pressure, heart rate, body temperature, and carotid blood flow variations and were randomised into four groups: control, EPO bolus 2400 IU kg–1, fractionated EPO (one injection a week of 600 IU kg–1 for 4 weeks), homologous red blood cell transfusion to reach the Ht level of the fractionated EPO group. A compression injury and a 75% stenosis of the carotid artery triggered a series of cyclic flow reductions (CFRs). CFRs were observed for a 20 min period in each group. Ear immersion bleeding time (BT) and hepato-splenic bleeding were performed at the end of the experiment. Biology was performed at the end of the thrombosis period: blood cells count, Hte, activated partial thromboplastin time, fibrinogen, arachidonic-induced platelet aggregation, EPO dosages.Results. – No significant increase in thrombosis (CFRs) in the two EPO groups and in the transfused group. Increase in Hte in the fractionated EPO group versus control. Group EPO bolus: decrease in BT and hepato-splenic bleeding versus control; decrease in hepato-splenic bleeding versus fractionated EPO group, increase in platelet aggregation velocity versus control.Conclusion. – EPO did not increase the thrombotic risk in this rabbit model. EPO bolus decreased BT and hepato-splenic bleeding. [Copyright &y& Elsevier]